Background: Bladder cancer ranks as the 10th most common cancer globally. The diagnosis of bladder tumors typically involves cystoscopy. Objective: This study aimed to evaluate the sensitivity and specificity of cystoscopy in detecting bladder tumors within a surveillance program following a bladder cancer diagnosis. Design, Setting, and Participants: This study utilized recordings of cystoscopies conducted at the Department of Urology, Zealand University Hospital, between July 2021 and November 2022. Clinical observations were cross-referenced with pathological results or follow-up cystoscopies. Clinically negative cystoscopies were further scrutinized for potential overlooked tumors. Outcome Measurements and Statistical Analysis: Sensitivity and specificity of cystoscopy were assessed through ROC curve analysis. Results and Limitations: A total of 565 cystoscopies were recorded, with 135 indicating clinical positivity. Among 181 cystoscopies with clinically negative results that underwent a follow-up cystoscopy, 17 patients (9.4%) were subsequently diagnosed with bladder cancer, with the lesions identified in the initial cystoscopy. The sensitivity and specificity of cystoscopy in these cases were 81% and 73%, respectively. Conclusion: This trial underscores the underdiagnosis and undertreatment of bladder tumors within the current surveillance program. Additionally, aggressive malignant lesions may be overlooked, heightening the risk of disease progression. Therefore, it is recommended that cystoscopies be complemented by other diagnostic methods to ensure accurate diagnosis and proper patient treatment. Patient Summary: This study involved 316 patients who underwent video-recorded cystoscopies and subsequent follow-up. Of these patients, 181 initially exhibited no clinical signs of bladder cancer. However, upon reviewing the recorded cystoscopy, bladder cancer was identified in 17 patients (9.4%).

Background: The surveillance of non-muscle invasive bladder cancer (NMIBC) requires frequent cystoscopies, which are costly and uncomfortable for patients. Uromonitor is a validated non-invasive urinary test for detecting NMIBC recurrence. However, data on its clinical benefit in an NMIBC surveillance program is limited. Objective: To assess the diagnostic accuracy of Uromonitor in NMIBC surveillance and its potential to limit the number of cystoscopies. Design, Setting, and Participants: The study included 202 patients with previous low-grade (LG) NMIBC tumors. Newly diagnosed patients were scheduled for flexible cystoscopy and Uromonitor test at 4, 12, and 24 months from the time of diagnosis. Patients with tumors diagnosed before entering the study underwent cystoscopy and Uromonitor test at the start of the study and 12 and 24 months from inclusion in the study. Outcome Measurements and Statistical Analysis: Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results and Limitations: Between February 2020 and October 2022, 202 patients were enrolled in the study. Of these patients, 171 met the eligibility criteria to perform the analysis, with a median age of 69 years, IQR (62–74), and 380 flexible cystoscopies with simultaneous Uromonitor tests. Overall, 39/171 (22.8%) patients had recurrences. Uromonitor showed a sensitivity of 89.7%, specificity of 96.2%, PPV of 72.9%, and NPV of 98.8%. In 28 cases, flexible cystoscopy was falsely positive, leading to surgery, where Uromonitor showed negative results. There were 13 cases of possible false positives for Uromonitor where flexible cystoscopy was negative. Conclusions: Uromonitor displays high diagnostic accuracy in detecting NMIBC recurrence with the potential for reducing the number of flexible cystoscopies in the follow-up of low- and intermediate-risk NMIBC. Patient Summary: We followed up on newly and previously diagnosed patients with LG NMIBC. We concluded that Uromonitor could potentially reduce the number of cystoscopies in NMIBC surveillance programs.

Bladder tumors constitute a substantial health challenge, yet advances in the treatment have been few. Electroporation is the use of brief electric pulses that permeabilize cell membranes with the purpose of a direct cytotoxic effect (irreversible electroporation) or for drug and gene delivery into cells (reversible electroporation). In this study, calcium was used (calcium electroporation). The use of electroporation in uro-oncology has been limited due to a lack of suitable instruments. The study focuses on the design and clinical usability of a new transurethral electrode and its technical performance in pigs. This fixed-geometry electrode consists of two opposing arrays of three needles each. The central needle is offset from an imaginary line between the two outermost needles. This ensures uniform, square-shaped electric field distribution. The electrode is compatible with a transurethral resectoscope and is an interchangeable working element through which the telescope inserts. The external pulse generator connects to the handle. Locking mechanisms ensure alignment of the equipment during assembly. The suitability was assessed in healthy porcine bladders, which resemble the human and allow the use of similar instruments. Under general anesthesia, the resectoscope was inserted transurethrally. Calcium was injected into the bladder wall with an endoscopic needle, the electrode was inserted, and the needles were placed in the area injected with calcium. Electric pulses were applied (8 pulses, 100 µs, 5000 Hz, and 400 V corresponding to 1000 V/cm voltage to electrode distance ratio). Afterwards the instruments were retracted. The handling of the instruments closely mirrors established urological techniques. The positioning of the electrode was visually managed, and the pulse delivery equaled standard transurethral procedures. Pulses were delivered successfully. The transurethral use and performance of the new electrode in the bladder aligns with existing urological instruments and techniques, enabling seamless adaptation by urologists.